Trends in HIV seropositivity in publicly funded HIV counseling and testing programs: implications for prevention policy.
BACKGROUND
We describe trends in seropositivity among clients attending publicly funded HIV counseling and testing sites across the United States and discuss implications for prevention policy.


METHODS
The present analysis used client-level data from 1990 through 1994 for 26 of 65 state, territorial, and local health departments receiving Centers for Disease Control and Prevention funds. Logistic regression was used to predict the proportion of HIV tests that were positive. Curves were created representing adjusted HIV seropositivity trends for 1990 through 1994.


RESULTS
HIV seropositivity rates were higher before 1992. Throughout, rates were higher among men, most racial/ethnic minorities tested, and persons 30 years or older. Although rates for men remained higher than those for women, the gap has narrowed in recent years. For both men and women, rates remained low for those reporting heterosexual activity as their only potential risk for HIV. Over time, more high-risk seronegatives are being repeatedly tested.


CONCLUSIONS
Lower, stabilized seropositivity rates after 1992 reflect large increases in testing volume, increasing frequency of repeat testing, and fewer asymptomatic-infected persons entering this public system. Various program innovations including enhanced outreach, improved access, rapid testing, and client-centered counseling should be considered as strategies to increase the number of infected persons who learn their serostatus early and enter into medical care.
Valdiserri
R O
RO
Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Weber
J T
JT
Frey
R
R
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D003376:Counseling / Q000191:economics / Q000458:organization & administration*; D005260:Female; D006078:Government Programs / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D006679:HIV Seropositivity / Q000453:epidemiology*; D015528:HIV Seroprevalence / Q000639:trends*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000191:economics / Q000458:organization & administration*; D008875:Middle Aged; D011050:Policy Making; D012044:Regression Analysis; D012307:Risk Factors; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology